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Tytuł pozycji:

Re-irradiation for malignant glioma: Toward patient selection and defining treatment parameters for salvage.

Tytuł :
Re-irradiation for malignant glioma: Toward patient selection and defining treatment parameters for salvage.
Autorzy :
Shen CJ; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Kummerlowe MN; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Redmond KJ; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Martinez-Gutierrez JC; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
Usama SM; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Holdhoff M; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Grossman SA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Laterra JJ; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Strowd RE; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Neurology, Wake Forest School of Medicine, Winston Salem, North Carolina.
Kleinberg LR; Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Źródło :
Advances in radiation oncology [Adv Radiat Oncol] 2018 Jul 10; Vol. 3 (4), pp. 582-590. Date of Electronic Publication: 2018 Jul 10 (Print Publication: 2018).
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Original Publication: [Philadelphia, PA] : Elsevier Inc., [2016]-
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Entry Date(s) :
Date Created: 20181030 Latest Revision: 20201001
Update Code :
20210623
PubMed Central ID :
PMC6200913
DOI :
10.1016/j.adro.2018.06.005
PMID :
30370358
Czasopismo naukowe
Purpose: Reirradiation for recurrent glioma remains controversial without knowledge of optimal patient selection, dose, fractionation, and normal tissue tolerances. We retrospectively evaluated outcomes and toxicity after conventionally fractionated reirradiation for recurrent high-grade glioma, along with the impact of concurrent chemotherapy.
Methods and Materials: We conducted a retrospective review of patients reirradiated for high-grade glioma recurrence between 2007 and 2016 (including patients with initial low-grade glioma). Outcome metrics included overall survival (OS), prognostic factors for survival, and treatment-related toxicity.
Results: Patients (n = 118; median age 47 years; median Karnofsky performance status score: 80) were re-treated at a median of 28 months (range, 5-214 months) after initial radiation therapy. The median reirradiation dose was 41.4 Gy (range, 12.6-54.0 Gy) to a median lesion volume of 202 cm 3 (range, 20-901 cm 3 ). The median cumulative (initial radiation and reirradiation combined) potential maximum brainstem dose was 76.9 Gy (range, 5.0-108.3 Gy) and optic apparatus dose was 56.0 Gy (range, 4.5-90.9 Gy). Of the patients, 56% received concurrent temozolomide, 14%, bevacizumab, and 11%, temozolomide plus bevacizumab; 19% had no chemotherapy. The planned reirradiation was completed by 90% of patients. Median OS from the completion of reirradiation was 9.6 months (95% confidence interval [CI], 7.5-11.7 months) for all patients and 14.0, 11.5, and 6.7 months for patients with initial grade 2, 3, and 4 glioma, respectively. On multivariate analysis, better OS was observed with a >24-month interval between radiation treatments (hazard ratio [HR]: 0.3; 95% CI, 0.2-0.5; P < .001), reirradiation dose >41.4 Gy (HR: 0.6; 95% CI, 0.4-0.9; P = .03), and gross total resection before reirradiation (HR: 0.6, 95% CI, 0.3-0.9; P = .02). Radiation necrosis and grade ≥3 late neurotoxicity were both minimal (<5%). No symptomatic persistent brainstem or optic nerve/chiasm injury was identified.
Conclusions: Salvage reirradiation, even at doses >41.4 Gy in conventional fractionation, along with chemotherapy, was safe and well tolerated with meaningful survival duration. These data provide information that may be useful in implementing safe reirradiation treatments for appropriately selected patients and guiding future studies to define optimal reirradiation doses, maximal safe doses to critical structures, and the role of systemic therapy.

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